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Donation of Frozen Embryo No Longer Needed for Reproduction for Embryonic Stem Cell Research University of Michigan MStem Cell Laboratories The following are the sequential steps to follow for donation of frozen embryos no longer needed for reproductive purposes to the University of Michigan’s MStem Cell Laboratories. 1) The Potential Donors should contact the facility where their frozen embryos are being stored. This may be a Fertility Healthcare Provider or Cryostorage Facility. Inform them of your desire to donate Frozen Embryos to the University of Michigan MStem Cell Laboratories for human embryonic stem cell research. 2) The Potential Donors should request that the Fertility Healthcare Facility Medical Director, Care Provider, or Cryostorage Facility Director of Operations register with the University of Michigan MStem Cell Laboratories. 3) The Facility Director or Care Provider will provide information to the University of Michigan MStem Cell Laboratories which will enable access to a secure website. 4) The Facility Director or Care Provider will electronically complete, sign, and return three documents to the MStem Cell Laboratories. - Certification of NIH Guideline Compliance for Frozen Embryo Donation Documentation of FDA Establishment, Registration and Listing of HTC/Ps and CLIA88 Compliance for Frozen Embryo Donation Inventory of Frozen Embryos to be Shipped to the University of Michigan for Human Embryonic Stem Cell Derivation. 5) Once these documents are received, reviewed, and approved by the University of Michigan MStem Cell Laboratories, the Facility Director or Care Provider will be instructed to provide the Potential Donors with: - University of Michigan Consent Form For Embryo Donation For Stem Cell Research A telephone number to call a University of Michigan Study Coordinator 6) The Potential Donors should read this Consent form. 1 7) Prior to signing the Consent Form, Potential Donors must talk with a Study Coordinator at the University of Michigan. This is an opportunity to ask any questions. 8) Both Potential Donors, the Egg Contributor and Sperm Contributor, of the embryos being donated must sign the consent in the presence of a Care Provider at the Fertility Healthcare Provider or Cryostorage Facility or in the presence of a Notary. PLEASE NOTE: This study is unable to accept embryos produced using donated egg or sperm. 9) The Potential Donors mail the Completed Consent to: - University of Michigan MStem Cell Laboratories 6428 Medical Science 1 1150 W. Medical Center Dr. Ann Arbor, MI 48109-0617 10) Once the University of Michigan MStem Cell Laboratories receives all documentation, we will coordinate embryo shipment from the Fertility Healthcare Provider or Cryostorage Facility to the University of Michigan. The University of Michigan will provide the shipper and payment for embryo transport. 2